Childhood Cancer Survivors Showed Higher Prevalence of Late Venous Thromboembolism

Survivors of childhood cancer had a higher prevalence of late venous thromboembolism (VTE) than community controls, according to an analysis of the St. Jude Lifetime Cohort Study (SJLIFE) published in Blood Advances.

Investigators from St. Jude Children's Research Hospital assessed the prevalence of and risk factors for VTE occurring 5 or more years after cancer diagnosis among 5,229 survivors treated at the hospital between 1962 and 2012, compared with 737 community controls. SJLIFE is a retrospective cohort with prospective clinical follow-up. Only grade 2 to 4 thromboses were included, and VTE events were confirmed with medical records.

Overall, 94 survivors (1.8%) had 108 late VTEs, compared with 5 controls (0.7%; P=.02). The cumulative incidence at age 45 years was 3.6% among survivors and 1.2% among controls (P=.018). At 35 years from diagnosis, cumulative incidence was highest among survivors of Hodgkin lymphoma 7.6%, compared with 2.8% among survivors of acute lymphoblastic leukemia and 2.2% among solid tumor survivors (P=.004). More than half of events (53.7%) occurred in an extremity, and 35.2% were pulmonary.

In multivariable models, late VTE was associated with chest-only radiation (odds ratio [OR], 2.0; 95% CI, 1.01-4.0), abdomen-only radiation (OR, 2.2; 95% CI, 1.04-4.8), and sex hormone use (OR, 2.2; 95% CI, 1.2-3.7). Combined chest and abdominal radiation fields were not associated with late VTE, and the investigators did not identify an association with chemotherapy. Early VTE, occurring less than 5 years from diagnosis, was not associated with late VTE.

The authors noted that differential surveillance may have led to under-ascertainment of VTE among controls, while undiagnosed VTE-related deaths may have led to underestimates. Temporal associations between sex hormone use and VTE, as well as prophylactic or other anticoagulation use, were not assessed. The investigators concluded that incorporating these factors into risk assessments may guide monitoring, prophylaxis, or interventions, particularly in high-risk situations.

Source: Jesudas R, Wang L, Chen Y, et al. Late venous thromboembolic events in survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study. Blood Adv. Published online September 30, 2026. doi:10.1182/bloodadvances.2026020935